Residency's end gives revealing look at dangerous gaps in coverage

LETTER — Posted July 24, 2006

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Regarding "AMA: Closing the uninsured gap hinges on personal coverage" (Article, July 3): My last month of residency has been perhaps one of my most educational months. During my residency in a large urban academic center that cares for veterans and Americans with limited financial resources, I have been somewhat sheltered from one of the most important details that affects families in America -- health insurance.

I learned more this month about how our current health insurance system keeps people from obtaining basic health care for themselves and their families. In addition, the lack of health insurance contributes to the leading cause of bankruptcy in our country -- medical bills and illness.

Upon graduation from residency, my husband and I will be two of the millions of self-employed Americans who need to obtain health insurance policies or choose to stay on COBRA coverage. We are examining different insurance options that are available, and we are finding it challenging to obtain coverage for our healthy family of two 30-year-old non-tobacco users with normal blood pressures, cholesterol and weights who have experienced one lifetime kidney stone and one Cesarean section for a now healthy 4-month-old child.

I have found policies that exclude maternity coverage altogether. Other policies exclude surgical obstetrical coverage. Policies issue lifetime riders for any kidney condition for the lifetime of the individual. Most policies offer extremely limited, if any, long-term care coverage or home health care, which makes care of a family member challenging when a person is kicked out of the hospital by the "utilization review police" and still requires some skilled care to recover appropriately and completely. Not to mention that you have to carefully look to see if the hospitals and doctors that you want are included on your insurance policy and review what is included in the policy if you are "out of network" or traveling out of state. I could not imagine being one of the millions of Americans with limited literacy skills who attempt to navigate the health insurance system on their own.

We are still looking for health insurance coverage.

When are we going to decide as a country that we need to take care of America and stop the current discrimination in health care? When are we going to decide that we need and want basic preventive health care for all Americans? Why do we make it so hard for families to maintain health and financial independence?

In the ERs I have worked in over the last year, the hospitals are frequently full, other hospitals divert patients and many patients have to wait hours for beds, contributing to long waiting room times, delays in care and clogged-up ERs. Space in the ER and hospitals seems to be more limited, and patients seem sicker, older and poorer. Most can not afford medications, exacerbating their conditions and producing time and financial strains on ERs, hospitals, families' jobs and our society. Many people have no doctor, insurance or optimal follow-up care plan.

When are we going to decide how to better care for the aging population? Where will the elderly live? How will their families care for them? If younger people will have to care for their elderly family members, who is going to work?

The current medical system for our elderly and self-employed Americans is unacceptable, dangerous, and does not improve the health and productivity of our society.

Christiana M. Lietzke, MD, Memphis, Tenn.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/07/24/edlt0724.htm.

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